Provider Demographics
NPI:1700220688
Name:OLIVE BRANCH FAMILY COUNSELING, LLC
Entity Type:Organization
Organization Name:OLIVE BRANCH FAMILY COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:HEFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-537-0014
Mailing Address - Street 1:121 TOWN ST
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-3023
Mailing Address - Country:US
Mailing Address - Phone:614-537-0014
Mailing Address - Fax:614-567-3167
Practice Address - Street 1:121 TOWN ST
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-3023
Practice Address - Country:US
Practice Address - Phone:614-537-0014
Practice Address - Fax:614-567-3167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2090322251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health